Comorbid Benign Paroxysmal Positional Vertigo in Idiopathic Sudden Sensorineural Hearing Loss: An Ominous Sign for Hearing Recovery

Objective: To determine characteristics and their prognostic value in idiopathic sudden sensorineural hearing loss (ISSNHL) with comorbid ipsilateral benign paroxysmal positional vertigo (BPPV). Study Design: Retrospective chart review. Setting: Tertiary referral center. Patients: Of the 374 patients with a diagnosis of ISSNHL at Seoul National University Bundang Hospital from January 2004 to December 2009, 32 patients (8.6%) with comorbid BPPV were recruited and compared with matched ISSNHL patients without BPPV. Interventions: Otologic and neurotologic examinations, pure-tone audiometry (PTA), vestibular function tests, and brain magnetic resonance imagings. Main Outcome Measures: Comparison of the findings of serial audiograms for 6 months and vestibular function tests in patients with ISSNHL and concurrent BPPV with those in age-matched ISSNHL patients without BPPV. Results: Patients with BPPV showed higher PTA averages than those without BPPV on initial and follow-up audiograms. Moreover, the improvement in PTA was less in the BPPV group than in the control. BPPV most commonly involved the posterior canal (17/32, 53.1%), followed by the horizontal canal (8/32, 25%), both the posterior and horizontal canals (6/32, 18.8%), and the anterior canal (1/32, 3.1%). Thirteen (40.6%) of 32 patients had recurrences of BPPV, 9 within a week and another 2 within 3 months. Conclusion: Comorbid BPPV is a negative prognostic indicator of auditory function in ISSNHL. Concurrent BPPV in ISSNHL suggests combined damage to the utricle and may indicate severe and widespread labyrinthine damage, leading to the poor prognosis.